NPIMap

Organization Active NPI

Nova Southeastern University, Inc

  • Dentist
  • North Miami Beach, FL
National Provider Identifier
1720226301
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
NOVA SOUTHEASTERN UNIVERSITY, INC
Practice address
1750 NE 167TH Street
North Miami Beach, FL 33162-3017
Phone
(954) 262-4100
Fax
(954) 262-1666
NPI assigned
Feb 4, 2009
Last updated
Jun 16, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
NOVA SOUTHEASTERN UNIVERSITY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert S. Oller, D.O.NPI 1811268626
Title
Ceo Clinical Operations
Phone
(954) 262-4343

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

1750 NE 167TH Street
North Miami Beach, FL 33162-3017

Mailing address

3200 S. University Drive
Sanford L. Ziff BLDG. 3Rd Floor, Room 4364-D
Ft. Lauderdale, FL 33328-2018
Phone (954) 262-4343

Other identifiers 1

IdentifierTypeStateIssuer
075174000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000987 FL Part B Supplier - Clinic/Group Practice 4486568896 Receives reassigned benefits from 259 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davie, FL; Wilton Manors, FL; Sunrise, FL; Plantation, FL; North Miami Beach, FL; Miami, FL; Ft Lauderdale, FL; Fort Lauderdale, FL

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Nova SE Univ38 organizations share this tax ID, including this one
Part of
Nova SE Univ

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1720226301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 S. UNIVERSITY DRIVE",
            "address_2": "SANFORD L. ZIFF BLDG. 3RD FLOOR, ROOM 4364-D",
            "city": "FT. LAUDERDALE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4343",
            "fax_number": "954-262-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 NE 167TH STREET",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331623017",
            "telephone_number": "954-262-4100",
            "fax_number": "954-262-1666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA SOUTHEASTERN UNIVERSITY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVA SOUTHEASTERN UNIVERSITY, INC",
        "enumeration_date": "2009-02-04",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "OLLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CEO CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "954-262-4343",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075174000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Miami Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.